Saturday, October 6, 2012

Safe-ening up birth in Uganda

I wanted to just write a bit about what we did in Kasana. I don't know that I did a very good job of explaining that before we went.

Shanti Uganda and Jane put together this awesome idea of having a doula training at Shanti. The midwives there have clinical skills but their training didn't expose them to things like dealing with traumatic birth, fetal positioning and how to influence it, VBAC, positions to ease pain, and all kinds of other things that doulas know like the backs of their hands.

They put together a training and invited Melinda and I to come along and co-teach it with Jane, so the three of us wrote a curriculum. Melinda did the structure and then we literally wrote it as we went each day, together. It was pretty fabulous.

(L-R) Jane, Bobby, Melinda (teaching), Sadie, Ildiko
Some of the volunteers that are on the ground at Shanti joined us as students for the workshop, and we brought some tagalongs from Canada and the US as well. All told, we had several countries represented which made the training an exercise in assumptions, absolutes, cultural sensitivity, mores, traditions, language - all kinds of things. We had the Ugandan midwives who come from different tribes, we had a Canadian student who was born and lived in Hungary, another Canadian student who works primarily with displaced women from all over the world including Sudan, the Democratic Republic of Congo. One of the three instructors was born and England, traveled the world and grew up in America and me, born here in America but raised in the Filipino culture. We had volunteers who have traveled and lived all over the world for lengths of time, a visitor from Zimbabwe who travels regularly to New Zealand and all over Africa, and we had a volunteer from Japan.

People ask me about diversity where I live. I'm not sure I realized what that even means until this trip!

Hazuki, Ritah & Sarah
The midwives in Uganda (as I understand it and I might not have this exactly correct) are nurses who have undergone their training, a part of which is rotation in different rotations of nursing. They do a three-month stint doing OB as a part of their training and if they enjoy it, can choose to become midwives. The Ugandan midwives are crying out for more training, they want to be able to get advanced degrees in midwifery and provide safer, better care for the women they serve, but for now, we have to fill in the blanks.

We brought 40+ hours of doula training to Shanti Uganda. There are no 'doulas' per se, in Uganda, but there are displaced Traditional Birth Attendants. TBAs are essentially the 'granny midwives' of Africa- most of the countries have them, I believe- women who were trained in the apprentice model to care for families and catch babies. The TBA who works at Shanti, Florence, is even certified as a TBA which is pretty neat that Uganda recognized their work in this way, until they were made illegal relatively recently.

Mama Viola and her son, Patrick, born into Jane's hands.
Viola asked Jane to name him, she chose to name him
after her husband, Pat.
We taught about the transition to parenthood, we talked pain coping techniques. We discussed positions for labor and demonstrated anatomically why they are important, and what they do for the mother and baby. We told many birth stories, we heard the midwives talk about how the Ugandan women come and deal with their labors, what they expect from their families for support, how involved fathers are. We visited the local hospital to see what the care is like there, and we saw a young boy who was very sick with tetanus and likely died within days of our visit. (That was very, very, very hard. Writing about this young boy and his mother does them NO service, does not do his story justice.)

They taught workshops for us on maternal health in Uganda, the goals they have of decreasing maternal and infant mortality, nutrition, local herbs and the importance of hygiene and diet. We learned about the herbs that are used on site, traditional medicines. We spent time with Florence and learned about how and why she became a TBA- turns out that the 'birth bug' bites women in any country, anywhere, the same way it bites us here.

All in all we taught a doula training, but the incredible thing is that we taught the midwives skills that will make birth gentler for the Ugandan women. They learned the reasons why women do some of the things they do in labor, which will make them more patient and understanding as care providers. We exchanged stories and they know that they have Sisters around the world who truly understand them, and what they are trying to do for Uganda, and her amazing women. We brought teaching supplies, medical supplies, basics like cloth menstrual pads and pens and paper, and baby clothes.

Melinda teaching while Madeline, Stella and Bobby take
it all in.
The trip wasn't small, of course. It cost a lot of money for me to go, and a lot of time to get the training together. It was an endeavor to get there (what with cancer, fundraising $6000, a trip to California, births), but in just 10 days, the very fact that we walked through the gate and sat down together, and shared our stories together, literally, makes birth safer, and better yet, happier there. Literally. Less women will transfer, less women will have cesareans, more women will go home feeling powerful, and recognized as strong, and beautiful, and accomplished. Less women will have to birth alone because now the midwives can come in and take a shift as a doula, and just be there for support.

And the most beautiful thing is that the Uganda midwives want to do it. They want to know more, and more, and more ways to help women in labor. They want more tools to be able to effectively teach, because they care about these women and their births. They want to be able to go back to school for higher degrees of learning. They want to pioneer and be on the leading edge of this dream of less death, and more satisfaction in birth.

This is absolute proof that little things do make an enormous difference. There was no hoop to jump through, we just dared to say YES. We just dared to push through our fears (oh boy, many changes to jump through that particular hoop!), and we changed the world, just a little bit.

Florence Nagawa, former TBA.
After finishing our course,she said, tearfully,
"I am no longer a TBA. Now, I am a doula!"
I remember my aunt used to talk about going to school. All my life I heard her dream about going to college and what she'd do, and who she'd be. One day I said to her, "Call and get a catalog. What can it hurt?" She was resistant- it was very emotional to just call and get the catalog! It is hard to make that first step. I said, "The hardest thing you'll ever do is make this first phone call. But think about it, it's just a phone call - no commitments, no money, just a phone call. So just do it." She did it, and on her own, ended up registering for school shortly thereafter.

So what are you waiting for? Dare to say yes- dare to try. Dare to be the change someone else needs in the world. It's hard, and it's sooo worth it.

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